| NPI | 1508839713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1135655) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305202570) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2009-01-28 |