| NPI | 1205132701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1236349) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MS PT4699) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2016-06-04 |