| NPI | 1760765192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1201659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P12927) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2011-09-22 |