| NPI | 1992840011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1215681) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: FL PT12887) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2026-03-26 |