| NPI | 1740729284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1283170) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 10251) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2017-02-16 |