| NPI | 1205285616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1239220) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14637) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-06-07 |