| NPI | 1962795229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004662) |
| 225100000X Physical Therapist (Licence: TX 1199029) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2011-05-19 |