| NPI | 1750899605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407585) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2129438) |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2025-11-21 |