| NPI | 1699356790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1325759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT35670) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-22 |