| NPI | 1053057752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 40001) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1361200) |
| 225100000X Physical Therapist (Licence: GA CP014574T) | |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2026-02-05 |