| NPI | 1851931679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1135499) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1135499) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2021-08-10 |