| NPI | 1790865590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1047066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 30356) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2022-03-18 |