| NPI | 1518741073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT20250217) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2025-08-06 |