| NPI | 1285047787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1206097) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2025-03-12 |