| NPI | 1154531986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 2471) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1129781) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |