| NPI | 1801898671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1354954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 02723) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-12-09 |