| NPI | 1952407447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4079) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1169942) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2008-01-15 |