| NPI | 1518434026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1369850) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2090566) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2023-03-01 |