| NPI | 1619940822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 087696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1130342) |
| 225100000X Physical Therapist (Licence: AZ 010373) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2025-12-21 |