| NPI | 1568047397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP003956T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62949) |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2021-03-15 |