| NPI | 1053922583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11868623-2401) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11868623-8016) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2021-12-01 |