| NPI | 1457571275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1088748) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1088748) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: TX 1088748) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2018-08-24 |