| NPI | 1396474466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2024-0202) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: DE J1-0014553) | |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2025-01-31 |