| NPI | 1750973319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13961180-2401) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2024-07-25 |