| NPI | 1427426808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1336310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30589) |
| 225100000X Physical Therapist (Licence: AL PTH8561) | |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2023-08-24 |