| NPI | 1184250094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1406777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 30029) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-06-04 |