| NPI | 1841675659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1300318) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 4004) |
| 225100000X Physical Therapist (Licence: TN 10422) | |
| 225100000X Physical Therapist (Licence: MS 5835) | |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2018-07-23 |