| NPI | 1972083731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP043576T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1359057) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2026-07-01 |