| NPI | 1467459396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1150108) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-01-16 |