| NPI | 1174878243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8369) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9399) |
| 225100000X Physical Therapist (Licence: TX 1273500) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2018-01-04 |