| NPI | 1437453065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 7662841-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 26227) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2025-09-30 |