| NPI | 1760180913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1368766) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT6177) |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2023-02-17 |