| NPI | 1841674835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1102036) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX 00517) |
| 225100000X Physical Therapist (Licence: PA PT009204E) | |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |