| NPI | 1730747619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1318797) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 14480045) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2024-10-23 |