| NPI | 1699542696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP038562T) |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2025-01-10 |