| NPI | 1154316891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1211946) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT28352) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2019-11-27 |