| NPI | 1265556567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1194947) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT13162) |
| 225100000X Physical Therapist (Licence: NV 0440) | |
| 225100000X Physical Therapist (Licence: WI 2815-24) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2010-11-14 |