| NPI | 1811224926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1282969) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31733) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2017-01-03 |