| NPI | 1922691419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20154) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1343160) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2024-12-24 |