| NPI | 1457112724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033859) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1387403) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-11-26 |