| NPI | 1962764282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8234986-2401) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 8234986-2401) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2024-02-22 |