| NPI | 1922706548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 14087160-2401) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2024-10-10 |