| NPI | 1932032778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2026022382) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP059525T) |
| Enumeration Date | 2026-06-03 |
| Last Update Date | 2026-07-09 |