| NPI | 1598978504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1119170) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37380) |
| 225100000X Physical Therapist (Licence: NM 3165) | |
| 225100000X Physical Therapist (Licence: TN PT0000002530) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-03-15 |