| NPI | 1023723509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32739) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1363750) |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2026-05-06 |