| NPI | 1972083244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 113162) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1195026) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2023-08-15 |