| NPI | 1366181463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12874613-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT6104) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2024-02-08 |