| NPI | 1821128455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1156880) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0287221) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2008-07-16 |