| NPI | 1588252241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1342042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3126027) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2022-10-05 |