| NPI | 1760031579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 106083-2401) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2020-12-02 |