| NPI | 1841744497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1403812) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 296053) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2026-09-05 |