| NPI | 1326342346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 76544502401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9255) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2015-05-27 |