| NPI | 1457503773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1204057) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 10014) |
| 225100000X Physical Therapist (Licence: MO 2009024721) | |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2012-04-05 |