| NPI | 1649664244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1096444) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL0010022) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2015-03-23 |