| NPI | 1912511031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1334175) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2025-01-08 |