| NPI | 1801376975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1340571) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295391) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2021-08-26 |