| NPI | 1225308745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1214108) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9648) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2012-02-15 |