| NPI | 1376202770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1362180) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 32106) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2022-07-12 |