| NPI | 1750640488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1218847) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3111342) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2022-11-15 |