| NPI | 1609320274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11140044-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61861) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2019-02-13 |