| NPI | 1760906119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 11-05666) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1292242) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2023-11-15 |