| NPI | 1841627296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1276533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 29117) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2023-11-15 |