| NPI | 1760153506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 12296564-2401) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-09-22 |