| NPI | 1003651845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CPO57744T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1393892) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2026-06-15 |