| NPI | 1376924480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 4131) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1257950) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2016-07-28 |