| NPI | 1093254989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16871) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1302056) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2025-06-06 |