| NPI | 1215372198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 366390-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4273) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2013-05-06 |