| NPI | 1932544319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1285240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4243) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2025-01-22 |