| NPI | 1194960591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 3492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1057578) |
| Enumeration Date | 2008-12-14 |
| Last Update Date | 2008-12-14 |