| NPI | 1417000753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 3082713-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 0652) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-01-23 |