| NPI | 1316111396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1152390) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: TX 1152390) |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2008-04-21 |