| NPI | 1851743629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT4796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1264085) |
| 225100000X Physical Therapist (Licence: NM 4796) | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2022-04-01 |