| NPI | 1639557101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1259107) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2019-08-02 |