| NPI | 1336870807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1365728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3129369) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2022-08-10 |