| NPI | 1720816986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2024-2036) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1383424) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-08-08 |