| NPI | 1578110128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1344584) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA CP048924T) |
| 225100000X Physical Therapist (Licence: GA CP050201T) | |
| 225100000X Physical Therapist (Licence: SC CP048923T) | |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2025-10-13 |