| NPI | 1225235260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX PT1169197) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2025-08-19 |