| NPI | 1275583569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1122232) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7610) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2013-12-02 |