| NPI | 1437981016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1396643) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2024-09-09 |