| NPI | 1619162542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1174211) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 717) |
| 225100000X Physical Therapist (Licence: NY 028934-1) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2010-01-16 |