| NPI | 1598153397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1253371) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT4758) |
| Enumeration Date | 2014-12-31 |
| Last Update Date | 2014-12-31 |