| NPI | 1760063713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11791538-2401) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2024-01-31 |