| NPI | 1760753743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1208555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 19672) |
| 225100000X Physical Therapist (Licence: NM 4057) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: TX 1208555) | |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2023-08-22 |