| NPI | 1770356784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1364161) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16126-24) |
| 225100000X Physical Therapist (Licence: AK 205310) | |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |