| NPI | 1366212904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 14193132-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 9064) |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2025-02-21 |