| NPI | 1043777329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14685) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1315497) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2021-01-14 |