| NPI | 1083061063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09422R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294311) |
| 225100000X Physical Therapist (Licence: TX 1274927) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2019-02-18 |