| NPI | 1093825093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1222793) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 3487) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-09-05 |