| NPI | 1962385674 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP051800T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP048534T) |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2025-12-22 |