| NPI | 1144401068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1163819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 14602) |
| 225100000X Physical Therapist (Licence: CO 7159) | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2009-05-08 |