| NPI | 1619941432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1176807) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 3783) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2024-06-03 |