| NPI | 1790102226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1086916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH6806) |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2014-03-21 |