| NPI | 1215006002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH3299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1358228) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-08-01 |