| NPI | 1497053490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1204432) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT25758) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2011-03-29 |