| NPI | 1548610553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1337680) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16381) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2020-10-07 |