| NPI | 1851882732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1307901) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3122015) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2021-02-26 |