| NPI | 1184060758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 15723) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: TX 1232237) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2025-02-04 |