| NPI | 1861122947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 32393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 14267594-2401) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2026-04-20 |