| NPI | 1851685978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1347841) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018625) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-07-29 |