| NPI | 1508439779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1347233) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2023-07-10 |