| NPI | 1295095305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1214093) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012001197) |
| 225100000X Physical Therapist (Licence: DE J1-0002787) | |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2012-05-22 |