| NPI | 1710105432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1107142) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: TX 1107142) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2010-11-04 |