| NPI | 1255035754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1374900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP038626T) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2025-10-15 |