| NPI | 1285184358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1282090) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1282090) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2025-08-14 |