| NPI | 1154874592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1282771) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2025-10-22 |