| NPI | 1881468064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1385314) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 308354) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2025-08-19 |