| NPI | 1003926676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP004769T) |
| Additional Taxonomies | 226300000X Kinesiotherapist |
| 225100000X Physical Therapist (Licence: TX 1173630) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-04-13 |