| NPI | 1528774015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1372467) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 6703) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2025-07-08 |