| NPI | 1487035846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1405174) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2110595) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2025-04-14 |