| NPI | 1841621604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1269277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT28784) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2021-07-26 |