| NPI | 1053960443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1338768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1111112) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2021-07-15 |