| NPI | 1013283761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37369) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1176130) |
| 225100000X Physical Therapist (Licence: FL 25146) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-03-27 |