| NPI | 1912484601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1336675) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2020-10-13 |