| NPI | 1447636816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT4111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1263986) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2018-12-19 |