| NPI | 1922448786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 9600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1281630) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-03-27 |