| NPI | 1922623388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215889) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 11775831-2401) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2025-11-26 |