| NPI | 1578306692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1393877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 307818) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2025-04-17 |