| NPI | 1407398605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17776) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1276171) |
| 225100000X Physical Therapist (Licence: AR 4129) | |
| Enumeration Date | 2016-11-06 |
| Last Update Date | 2025-08-08 |