| NPI | 1407579634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1387292) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29172) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2024-01-06 |