| NPI | 1518122100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 7833639-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07391) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2011-04-01 |