| NPI | 1932696721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1196318) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: TX 1196318) | |
| 314000000X Skilled Nursing Facility (Licence: TX 1196318) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2023-08-28 |