| NPI | 1033849229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11274) |
| 225100000X Physical Therapist (Licence: TX 1393345) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-08-01 |