| NPI | 1154332625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1026599) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 2442) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |