| NPI | 1114387198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1269506) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0018558) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2024-05-31 |