| NPI | 1497165708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2015018389) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 28443) |
| 225100000X Physical Therapist (Licence: TX 1344532) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2025-02-15 |