| NPI | 1508525866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1355358) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2121216) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2026-03-03 |