| NPI | 1568475234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1120277) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 1120277) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2009-03-25 |