| NPI | 1942623426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1250143) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 31076) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2024-03-30 |