| NPI | 1316326911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2015017587) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1259336) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2015-06-09 |