| NPI | 1588439368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP035425T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 015216) |
| 225100000X Physical Therapist (Licence: MO CP031601T) | |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2024-11-02 |