| NPI | 1326038340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1070431) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 000566) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2023-08-31 |