| NPI | 1336308212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1166960) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 2876) |
| 225100000X Physical Therapist (Licence: AK 1937) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |