| NPI | 1851005292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1391342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0018626) |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2024-07-31 |