| NPI | 1598122657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 96403242401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 96403248016) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-02-10 |