| NPI | 1609654664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019020965) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07365) |
| 225100000X Physical Therapist (Licence: TX 1394668) | |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2025-08-25 |