| NPI | 1710349444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10953735-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3283) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2021-12-06 |