| NPI | 1225576606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP017265T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 4262) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2025-03-31 |