| NPI | 1740529726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1238430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037152) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2014-01-03 |