| NPI | 1801142617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1257393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 42771) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2022-02-16 |