| NPI | 1689317786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP-025323T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1347784) |
| Enumeration Date | 2022-04-16 |
| Last Update Date | 2023-10-03 |