| NPI | 1518198126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1190542) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031442-1) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2009-08-13 |