| NPI | 1982142089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1284298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 4257) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2021-01-04 |