| NPI | 1134838865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1370684) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT39461) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2023-02-22 |