| NPI | 1235736216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21856) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT-2023-2213) |
| Enumeration Date | 2020-10-03 |
| Last Update Date | 2025-12-18 |