| NPI | 1124728126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1394582) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH11002) |
| 225100000X Physical Therapist (Licence: NM PT-2023-2192) | |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2024-07-16 |