| NPI | 1487246526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 304025) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1340262) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-09-13 |