| NPI | 1689148454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11087472-2401) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 11087472-2401) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2026-04-17 |