| NPI | 1457964470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12078806-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0017202) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2026-06-27 |