| NPI | 1356721583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15303) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1260610) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2023-01-23 |