| NPI | 1427595586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-4593) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 12783) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2019-01-11 |