| NPI | 1811238470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1327028) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009666) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2021-04-07 |