| NPI | 1275495160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1407677) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070029426) |
| Enumeration Date | 2025-11-29 |
| Last Update Date | 2025-12-02 |