| NPI | 1063278000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1387955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP028106T) |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2024-02-27 |