| NPI | 1801921598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018125) |
| 225100000X Physical Therapist (Licence: TX 1169143) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2009-03-09 |