| NPI | 1770703399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1266919) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21113) |
| 225100000X Physical Therapist (Licence: NY 025146) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-06-05 |