| NPI | 1881232569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 13264473) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 13264473) |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2020-01-30 |