| NPI | 1841025806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1403051) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 27956) |
| 225100000X Physical Therapist (Licence: NY 052527) | |
| Enumeration Date | 2024-09-07 |
| Last Update Date | 2025-01-31 |