| NPI | 1538349709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1178099) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 10629) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2023-09-15 |