| NPI | 1144060062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1398903) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3132788) |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-08-23 |