| NPI | 1245481613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1204921) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL CP061080T) |
| 225100000X Physical Therapist (Licence: OR CP061081T) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2026-08-13 |