| NPI | 1235857830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1316562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028147) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2025-09-15 |