| NPI | 1083071864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1266060) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039173) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2017-05-08 |