| NPI | 1811462351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA PT09868) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1302513) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2018-10-11 |