| NPI | 1699380907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 1518724) |
| 225100000X Physical Therapist (Licence: TX 1337799) | |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2025-07-18 |