| NPI | 1629458773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1340679) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42555) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-01-20 |