| NPI | 1437716768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2023-2324) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 11285965-2401) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2023-10-20 |