| NPI | 1447130570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3134427) |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-11-10 |