| NPI | 1457419442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1154500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028792-1) |
| 225100000X Physical Therapist (Licence: LA 04027R) | |
| 225100000X Physical Therapist (Licence: FL PT14777) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |