| NPI | 1871333757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13861670-2401) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: UT 13861670-2401) |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-07-17 |