| NPI | 1013064559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1156399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2434) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2024-01-15 |