| NPI | 1003982422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1317216) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 0262791) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2019-07-23 |