| NPI | 1457524431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1174720) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61603) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2023-05-30 |