| NPI | 1992405658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5226) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1373687) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-06-26 |