| NPI | 1194054593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37045) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1193133) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2026-07-21 |