| NPI | 1568804060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1335783) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2098967) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2021-12-14 |