| NPI | 1326335696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1220893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 08109) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2026-07-15 |