| NPI | 1063373488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 6688) |
| Enumeration Date | 2025-11-24 |
| Last Update Date | 2026-03-30 |