| NPI | 1811508948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1335453) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 1335453) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2022-07-26 |