| NPI | 1194516849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407050) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14698) |
| 225100000X Physical Therapist (Licence: GA PT017674) | |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-09-02 |