| NPI | 1740020965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1393670) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS CP060005T) |
| Enumeration Date | 2024-05-27 |
| Last Update Date | 2026-07-31 |