| NPI | 1174050546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1289956) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32475) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2025-04-28 |