| NPI | 1013325844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1187209) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 06351) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2014-07-25 |