| NPI | 1043728538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3121670) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2024-01-25 |