| NPI | 1316259484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1214033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60160972) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2025-09-03 |