| NPI | 1689269813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 1343415) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1343415) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2023-04-05 |