| NPI | 1396625315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP048971T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1407269) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-09-03 |