| NPI | 1003416645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11926426-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY CP049997T) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2025-11-07 |