| NPI | 1437853595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 1275711897) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2024-05-15 |