| NPI | 1629792890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP015272T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP026482T) |
| 225100000X Physical Therapist (Licence: TX 1367864) | |
| Enumeration Date | 2022-09-30 |
| Last Update Date | 2023-12-15 |