| NPI | 1770799900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 1504) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1016434) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2010-09-23 |