| NPI | 1942431861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1196410) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-020112) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2020-02-03 |