| NPI | 1861754087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1212723) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009226) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-06-13 |