| NPI | 1003296773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1296743) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038803-1) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2019-12-08 |