| NPI | 1316713316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1406673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT40291) |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2025-05-09 |