| NPI | 1881072874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25479) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1254941) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2018-04-20 |