| NPI | 1497518823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13670860-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 6323) |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-11-04 |