| NPI | 1689767063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4047) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1156153) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2007-07-08 |