| NPI | 1750064473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1379319) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1379319) |
| 2251S0007X Physical Therapist, Sports (Licence: TX 1379319) | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2026-06-12 |