| NPI | 1073039665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211375) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1306068) |
| 225100000X Physical Therapist (Licence: SC 9047) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2024-02-29 |