| NPI | 1912641291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1391353) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41472) |
| Enumeration Date | 2022-04-23 |
| Last Update Date | 2025-04-28 |