| NPI | 1770243537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1355886) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT39726) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2026-07-29 |