| NPI | 1285348409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13147555-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 13147555-8016) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-02-16 |