| NPI | 1841419629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1147810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 6697) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2009-09-09 |