| NPI | 1659710978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8602203-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2841) |
| 225100000X Physical Therapist (Licence: AZ 10995) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2015-11-17 |