| NPI | 1063899151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9364119-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023545) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2015-06-25 |