| NPI | 1659692606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT5025) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1196020) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2025-10-09 |