| NPI | 1477393924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 17008) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3132775) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-12-19 |