| NPI | 1508392101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09616) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: TX 1356367) | |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2023-04-11 |