| NPI | 1669238317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP029322T) |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |