| NPI | 1891133906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8591913-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2832) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2016-04-06 |