| NPI | 1992137608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1234493) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3268) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2020-10-14 |