| NPI | 1265764864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1180068) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 016541) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2010-02-05 |