| NPI | 1679896534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1137768) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX 1137768) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2010-03-08 |