| NPI | 1790356624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1349362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP051459T) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 306170) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2026-01-16 |