| NPI | 1427775105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1406739) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 1406739) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2025-06-21 |