| NPI | 1629350582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT CP027707T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1211061) |
| 2251S0007X Physical Therapist Sports (Licence: SC 9882) | |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2024-06-20 |