| NPI | 1629273057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1181390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 2094) |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2012-01-03 |