| NPI | 1144230525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK PT1863) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1-4404-8) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2007-07-08 |