| NPI | 1932643798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1285153) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2025-09-07 |