| NPI | 1366954752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: TX 1294786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63005) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2018-10-09 |