| NPI | 1023200169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1206275) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2024-04-29 |