| NPI | 1376595181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407517) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT9760) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-11-21 |