| NPI | 1619376605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1206400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07777F) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-08-15 |