| NPI | 1841963691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1371718) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10902) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2023-03-27 |