| NPI | 1063274801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 14229073-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 12213) |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2025-08-04 |