| NPI | 1861920894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1300399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210978) |
| Enumeration Date | 2017-06-04 |
| Last Update Date | 2023-05-23 |