| NPI | 1275726432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1385015) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0011842) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2023-11-07 |