| NPI | 1467070748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP038649T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1378720) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2025-01-21 |