| NPI | 1699149567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1267530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5062) |
| 225100000X Physical Therapist (Licence: IL 070021583) | |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2015-11-16 |