| NPI | 1194065680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1242145) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012023495) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2014-07-21 |