| NPI | 1790931913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1377936) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030470) |
| 225100000X Physical Therapist (Licence: NV 3571) | |
| 225100000X Physical Therapist (Licence: CA 295018) | |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2024-06-07 |