| NPI | 1922099670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1230520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT7173) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2023-03-31 |