| NPI | 1659892503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1269643) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ PT13045) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2020-12-02 |