| NPI | 1477439412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP058443T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1407100) |
| Enumeration Date | 2025-08-14 |
| Last Update Date | 2026-07-08 |