| NPI | 1295242626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018037141) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1292928) |
| 225100000X Physical Therapist (Licence: OK 5427) | |
| 225100000X Physical Therapist (Licence: AL PTH8877) | |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-10-15 |