| NPI | 1790710713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1088979) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1088979) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-09-29 |