| NPI | 1750672796 |
|---|---|
| Professional Name | NA NA NA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1205400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 8822) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2011-09-09 |