| NPI | 1669888723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1171320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2005007819) |
| 225100000X Physical Therapist (Licence: AL PTH7051) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2014-07-09 |