| NPI | 1518435510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1406922) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041598) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2025-12-30 |