| NPI | 1790208429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1386612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041504) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2024-02-26 |