| NPI | 1942920178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP025698T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 5038) |
| 225100000X Physical Therapist (Licence: OH PT020188) | |
| 225100000X Physical Therapist (Licence: SC CP022870T) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-02-20 |