| NPI | 1659629251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11819267-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 39130) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2025-12-08 |