| NPI | 1700269214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8840) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 09138R) |
| 225100000X Physical Therapist (Licence: TX 1259022) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2023-08-23 |