| NPI | 1366959793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21641) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1300359) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2022-09-29 |