| NPI | 1366592479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1150609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10256) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2026-06-29 |