| NPI | 1497033633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1250831) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 26669) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2015-10-24 |