| NPI | 1487166583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1293783) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK CP009951T) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2021-12-28 |