| NPI | 1710251558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1214601) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037372) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2022-04-04 |