| NPI | 1760563605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1108207) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: TX 1108207) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2024-06-12 |