| NPI | 1326426578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9371435-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013052) |
| 225100000X Physical Therapist (Licence: MA 20982) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |