| NPI | 1386299089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1325014) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P18996) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2019-11-01 |