| NPI | 1861234791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07503) |
| 225100000X Physical Therapist (Licence: TX 1393744) | |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-09-18 |