| NPI | 1245656289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1200433) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37866) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2018-08-27 |