| NPI | 1700650207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 12199R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1400726) |
| 225100000X Physical Therapist (Licence: FL PT41043) | |
| 225100000X Physical Therapist (Licence: AZ LPT-034054) | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2025-11-11 |