| NPI | 1457935686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 13333) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019022794) |
| 225100000X Physical Therapist (Licence: TX 1318710) | |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2021-05-12 |