| NPI | 1285744128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1250360) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: FL PT22502) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-03-09 |