| NPI | 1992976435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: VA 2305216922) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216922) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305216922) | |
| 225100000X Physical Therapist (Licence: TX 1163040) | |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2026-07-29 |