| NPI | 1740634724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1348164) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30535) |
| Enumeration Date | 2016-04-16 |
| Last Update Date | 2022-03-04 |