| NPI | 1376928168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1381913) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2112456) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2023-08-22 |