| NPI | 1891457362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1373026) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2165364) |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2025-01-26 |