| NPI | 1225548522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1290169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26672) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2025-11-05 |