| NPI | 1053769968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1271122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014136) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2023-07-28 |