| NPI | 1225698210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5415) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT5503) |
| 225100000X Physical Therapist (Licence: TX 1324750) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-01-19 |