| NPI | 1174898100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034409) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1213350) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2012-03-08 |