| NPI | 1881059228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1271579) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3118520) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2021-05-11 |