| NPI | 1407652449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1405058) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT44945) |
| Enumeration Date | 2025-02-20 |
| Last Update Date | 2026-08-05 |