| NPI | 1861733305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1217131) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 27283) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2013-03-07 |