| NPI | 1033915061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP042531T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1405670) |
| Enumeration Date | 2025-02-20 |
| Last Update Date | 2025-02-20 |