| NPI | 1063296838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 138552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP038449T) |
| 225100000X Physical Therapist (Licence: OK CP032198T) | |
| 225100000X Physical Therapist (Licence: CO CP029541T) | |
| 225100000X Physical Therapist (Licence: AZ CP026798T) | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2025-03-18 |