| NPI | 1689042715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1265953) |
| Enumeration Date | 2015-09-06 |
| Last Update Date | 2015-09-29 |