| NPI | 1851522049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1272375) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2009022385) |
| 225100000X Physical Therapist (Licence: KS 11-04010) | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2018-09-14 |