| NPI | 1033788930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT CP027669T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1345597) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-02-01 |