| NPI | 1477918258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT CP050654T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 65463) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2025-11-10 |