| NPI | 1568586188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 31378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1155820) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2025-12-11 |