| NPI | 1902528060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1403791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 302861) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2025-12-18 |