| NPI | 1023431293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1257660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036310-1) |
| 225100000X Physical Therapist (Licence: VA 2305208013) | |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2022-07-21 |