| NPI | 1699364877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 174385) |
| 225100000X Physical Therapist (Licence: TX 1377738) | |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2024-09-12 |