| NPI | 1548084353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407727) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NH CP046825T) | |
| Enumeration Date | 2024-11-09 |
| Last Update Date | 2025-12-18 |