| NPI | 1285955583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 7649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1204093) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-09-15 |