| NPI | 1689410771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2020013611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1322804) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2024-07-08 |