| NPI | 1346431459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205554) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1175190) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-02-07 |