| NPI | 1023583226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT5299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1135267) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2018-10-04 |