| NPI | 1568139905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP026699T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1350639) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2024-02-13 |