| NPI | 1407488562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1328172) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 1328172) |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2025-08-06 |