| NPI | 1619179488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1233630) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007319) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-01-07 |