| NPI | 1780628271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 2431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1072890) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2012-09-27 |