| NPI | 1306133756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1228012) |
| Additional Taxonomies | 174400000X Specialist (Licence: OK 4422) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2013-03-20 |