| NPI | 1528426988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 7304875-2401) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2023-11-27 |