| NPI | 1740530757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08392) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4770) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT29649) | |
| 225100000X Physical Therapist (Licence: TX 1222932) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2022-08-10 |