| NPI | 1225267115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1189412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4009) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2014-10-23 |