| NPI | 1013892686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP053964T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP058232T) |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2026-06-21 |