| NPI | 1225088834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1129872) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0011908) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2025-08-29 |