| NPI | 1235756032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 36673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO CP001239T) |
| 225100000X Physical Therapist (Licence: TX 1328774) | |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2024-07-05 |