| NPI | 1932792173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1343183) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2025-10-15 |