| NPI | 1104926443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4795) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1054674) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-01-27 |