| NPI | 1376570937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1171098) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT3230) |
| 225100000X Physical Therapist (Licence: LA 04548R) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2019-04-13 |