| NPI | 1205702867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2025-0244) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1406857) |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: NM PT-2025-0244) | |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: TX 1406857) | |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-13 |