| NPI | 1285518597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1407249) |
| Enumeration Date | 2025-08-01 |
| Last Update Date | 2025-09-24 |