| NPI | 1447638788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08806) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1256807) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2019-08-19 |