| NPI | 1134135569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63181) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1157800) |
| 225100000X Physical Therapist (Licence: AZ 9154) | |
| 225100000X Physical Therapist (Licence: ID PT-2251) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-04-09 |