| NPI | 1821597758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10579591-2401) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 10579591-2401) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2026-06-08 |