| NPI | 1932710555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP007626T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014839) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2021-09-16 |