| NPI | 1003985565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1104438) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2019-01-15 |