| NPI | 1871018531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1378082) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP011151T) |
| 225100000X Physical Therapist (Licence: GA PT013053) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2023-07-28 |