| NPI | 1588000327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1224153) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12290 - 24) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2013-05-20 |