| NPI | 1982720579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 58473842401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP050809T) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2025-11-05 |