| NPI | 1164231882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1383061) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR CP039319T) |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-01-07 |