| NPI | 1548209372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1161190) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: TX 1161190) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |