| NPI | 1518963362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1011591) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 752803659) |
| 1744R1103X Specialist, Research Data Abstracter/Coder (Licence: TX 752803659) | |
| 225100000X Physical Therapist (Licence: NM 4674) | |
| 225100000X Physical Therapist (Licence: OK 2429) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2016-09-13 |