| NPI | 1609213511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1232576) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3113566) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2013-08-06 |