| NPI | 1447808878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1261676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV CP002555T) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2020-04-15 |