| NPI | 1356812663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1386554) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043916) |
| Enumeration Date | 2018-12-13 |
| Last Update Date | 2023-12-13 |