| NPI | 1487894226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1161680) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1161680) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2023-08-25 |