| NPI | 1942330519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1150423) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3249) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2018-03-20 |