| NPI | 1861386187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP049524T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP044817T) |
| 225100000X Physical Therapist (Licence: IN 05015992A) | |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2025-09-17 |