| NPI | 1346731916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 10207R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1298768) |
| 225100000X Physical Therapist (Licence: SC 9462) | |
| Enumeration Date | 2018-05-19 |
| Last Update Date | 2020-02-26 |