| NPI | 1255439154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1151417) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 0090014) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2010-11-03 |