| NPI | 1124919949 | 
|---|---|
| Entity Type | Individual | 
| Gender | N/A | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP046569T) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP049797T) | 
| Enumeration Date | 2025-07-10 | 
| Last Update Date | 2025-10-13 |