| NPI | 1144775164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1348341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040704) |
| 225100000X Physical Therapist (Licence: IL 070022883) | |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2023-04-18 |