| NPI | 1205394277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1349610) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019007769) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2021-12-09 |