| NPI | 1568647345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1292527) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-1094) |
| Enumeration Date | 2007-12-30 |
| Last Update Date | 2022-01-19 |