| NPI | 1790200939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019263) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11546) |
| 225100000X Physical Therapist (Licence: TX 1318973) | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2024-07-31 |