| NPI | 1396101572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10742164-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3261) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2024-09-10 |