| NPI | 1083969752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17891) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1226262) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2024-10-29 |