| NPI | 1235864505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32416) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 16899) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2026-01-15 |