| NPI | 1144943978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP018793T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: LA CP015317T) | |
| 225100000X Physical Therapist (Licence: MS PT-7442) | |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2023-03-30 |