| NPI | 1407854367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA PT-381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1040277) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2019-11-12 |