| NPI | 1386478808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16759-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP033673T) |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2026-02-05 |