| NPI | 1255963534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1400556) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT6840) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2024-11-20 |