| NPI | 1073231635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23784) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1401471) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2025-07-17 |