| NPI | 1679978225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1252362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3116480) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2026-02-20 |