| NPI | 1780246694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1295771) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 296610) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2019-07-01 |