| NPI | 1487343653 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13397961-2401) | 
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: UT 13397961-2401) | 
| Enumeration Date | 2023-05-03 | 
| Last Update Date | 2023-06-14 |