| NPI | 1396271326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11337985-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12903) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-01-22 |