| NPI | 1346795598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8593) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1278222) |
| 225100000X Physical Therapist (Licence: MS PT6086) | |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2022-01-07 |