| NPI | 1063763506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1353382) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11683) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2025-08-01 |