| NPI | 1689007635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1209970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39040) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2021-07-28 |