| NPI | 1932540523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1192290) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030126) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2013-07-10 |