| NPI | 1033382544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1166150) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6353) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2020-06-18 |