| NPI | 1760933444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1249761) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4852) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2017-02-28 |