| NPI | 1194721704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 121905-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 4616) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2017-10-24 |