| NPI | 1114238086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1197830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3108858) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2018-03-17 |