| NPI | 1952184640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215941) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2026-05-12 |