| NPI | 1164660510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23107) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029799) |
| 225100000X Physical Therapist (Licence: IA 004138) | |
| 225100000X Physical Therapist (Licence: TX 1184418) | |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2016-09-02 |