| NPI | 1194982199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 9947) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1129138) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2008-05-19 |