| NPI | 1003972092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1201719) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 1201719) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2025-12-10 |