| NPI | 1639883879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: AZ 31383) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: TX 1334804) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-07-31 |