| NPI | 1033567862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12567678-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4473) |
| 225100000X Physical Therapist (Licence: ID 4627) | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2022-01-25 |