| NPI | 1205981628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 284982-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 849822401) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-12-03 |