| NPI | 1093052516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28644) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1218785) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2013-10-17 |