| NPI | 1710173513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16326) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1179450) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2025-01-15 |