| NPI | 1043747934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 5051) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1289862) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2017-05-22 |