| NPI | 1740434117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1185610) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 06488) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2011-11-15 |