| NPI | 1023156676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1142479) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL CP056510T) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2026-07-20 |