| NPI | 1912625666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1367089) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225200000X Physical Therapy Assistant (Licence: TX 1367089) | |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-31 |