| NPI | 1720761430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11932R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1379577) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2024-09-10 |