| NPI | 1699153437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 09020R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1253997) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2015-05-13 |