| NPI | 1649510520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1224026) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60330419) |
| Enumeration Date | 2013-02-28 |
| Last Update Date | 2013-11-20 |