| NPI | 1811698988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 12122R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1373595) |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2026-02-19 |