| NPI | 1568610616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 24248) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1102622) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2015-10-06 |