| NPI | 1982216206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11772426-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63795) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2024-05-02 |