| NPI | 1023426160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9161047-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-7574) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2015-01-05 |