| NPI | 1336218874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1029361) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5246) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2025-09-11 |