| NPI | 1538956644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020738) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1406658) |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2025-08-02 |