| NPI | 1588127484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1312954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 296170) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2022-04-19 |