| NPI | 1790019875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1167673) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1167673) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2021-08-20 |