| NPI | 1750484978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1079754) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP049544T) |
| 225100000X Physical Therapist (Licence: OH CP050541T) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1079754) | |
| 2251S0007X Physical Therapist, Sports (Licence: TX 1079754) | |
| 225100000X Physical Therapist (Licence: PA CP050536T) | |
| 225100000X Physical Therapist (Licence: SC CP049545T) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2025-12-03 |