| NPI | 1629005301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 3133172401) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: UT 313317-2401) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2026-05-13 |