| NPI | 1396820148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1049237) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 101058) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2014-11-20 |