| NPI | 1912617440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1343346) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP031237T) |
| 225100000X Physical Therapist (Licence: MD CP034932T) | |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2025-04-30 |