| NPI | 1780845594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12040712-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1181228) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2021-06-03 |