| NPI | 1568182509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1365093) |
| 225100000X Physical Therapist (Licence: CO CP048502T) | |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2025-11-19 |