| NPI | 1720697816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1390568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10503) |
| 225100000X Physical Therapist (Licence: CO PTL.0018179) | |
| 225100000X Physical Therapist (Licence: AZ LPT-33106) | |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2024-04-15 |