| NPI | 1578576898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1128288) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1350) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2023-12-13 |