| NPI | 1942448238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1288000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8241) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2019-11-25 |