| NPI | 1235487570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1241520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6824) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2014-10-29 |