| NPI | 1942062104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13149266-2401) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 13149266-2401) |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2026-04-22 |