| NPI | 1538992417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1354342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11949) |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2025-08-11 |