| NPI | 1750625737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1378871) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT39558) |
| 225100000X Physical Therapist (Licence: IN 05013792A) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2025-11-25 |