| NPI | 1700450491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1408171) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 12273912-8016) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2026-06-12 |