| NPI | 1790090595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1191980) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11187) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2012-04-26 |