| NPI | 1598659088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 14222725-2401) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: UT 14222725-2401) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: UT 14222725-2401) | |
| Enumeration Date | 2025-06-07 |
| Last Update Date | 2025-11-14 |