| NPI | 1194183574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1258999) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 43221) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2017-05-09 |