| NPI | 1023347044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1316343) |
| Additional Taxonomies | 171W00000X Contractor (Licence: MO 2007008282) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2025-07-08 |