| NPI | 1811610348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1367965) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP034875T) |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2025-03-04 |