| NPI | 1740134493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP053883T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1407952) |
| Enumeration Date | 2026-02-20 |
| Last Update Date | 2026-03-04 |