| NPI | 1447650288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 06767F) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1187689) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2014-08-29 |