| NPI | 1477959328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10405007-2401) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225100000X Physical Therapist (Licence: ID 6623) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2023-03-09 |