| NPI | 1144755711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 10168416-2401) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2020-03-11 |