| NPI | 1396471868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1383138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10794) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2024-05-10 |