| NPI | 1942615778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32979) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1105276) |
| 225100000X Physical Therapist (Licence: TX 134506) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2023-08-22 |