| NPI | 1043592587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1330204) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3024) |
| Enumeration Date | 2011-09-11 |
| Last Update Date | 2022-01-04 |