| NPI | 1861571648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 283650-2401) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: UT 283650-2401) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2026-06-08 |