| NPI | 1154646651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1195447) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 1433) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2011-12-15 |