| NPI | 1649944018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX OR230977) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1348949) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2025-12-22 |