| NPI | 1013540822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10005) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1312829) |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2021-12-10 |