| NPI | 1407153620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1216579) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3919) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2014-04-15 |