| NPI | 1740794544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1311538) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT33247) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2018-09-24 |