| NPI | 1124596937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1323516) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 295837) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2024-03-14 |