| NPI | 1841847191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1363133) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT297053) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2022-12-20 |