| NPI | 1033608542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1339897) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213178) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2026-04-03 |