| NPI | 1952875031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1309501) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 15306) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2023-09-29 |