| NPI | 1154062651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP11272T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 119898-2401) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2023-04-14 |