| NPI | 1548689714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 005354) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1241822) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2025-04-15 |