| NPI | 1902014087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1158430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292881) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2020-04-12 |