| NPI | 1548690837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1237856) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2015-01-22 |