| NPI | 1750336517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1167928) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 15739) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2012-03-13 |