| NPI | 1093442881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2025015751) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1370272) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2025-05-22 |