| NPI | 1205479516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1323088) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP031550T) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2024-05-28 |