| NPI | 1104000264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1205293) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013568) |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2011-07-29 |