| NPI | 1346890217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP003424T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY TP2019099) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2020-10-02 |