| NPI | 1326727496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 14116621) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-33029) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2024-09-04 |