| NPI | 1124433446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 2719535-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2968) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2023-02-24 |