| NPI | 1558983437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT CP002849T) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ND 2267) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2020-06-09 |