| NPI | 1114382983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61620) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1247892) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2016-07-21 |