| NPI | 1255412904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1222302) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS PT3573) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2025-04-29 |