| NPI | 1538170022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13894390-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 27481) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-06-20 |