| NPI | 1902913635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1102515) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX PT1102515) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2022-03-15 |