| NPI | 1750782710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1095750) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 01890) |
| 225100000X Physical Therapist (Licence: AR 1952) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2014-09-09 |