| NPI | 1245590561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1188608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 3458) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |