| NPI | 1720795271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1370114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3129807) |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2022-11-07 |