| NPI | 1366775199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PT011513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1177460) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2016-01-12 |