| NPI | 1003327438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2024-0271) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NM PT-2024-0271) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2025-12-10 |