| NPI | 1811127830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 3712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1188951) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2009-07-24 |