| NPI | 1770996886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1178327) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: TX 1178327) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2019-02-11 |