| NPI | 1154751972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7319) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1237046) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2014-10-21 |