| NPI | 1851020739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP026297T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CA 303492) | |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2023-11-30 |