| NPI | 1619455177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8254135-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3789) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2024-02-16 |