| NPI | 1871073668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1287167) |
| Additional Taxonomies | 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: NM PT-2023-2047) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2025-11-05 |