| NPI | 1154551240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1072742) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 738346) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |