| NPI | 1023509098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1307600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 303438) |
| 225100000X Physical Therapist (Licence: HI PT-5608) | |
| 225100000X Physical Therapist (Licence: TX 3121959) | |
| 225100000X Physical Therapist (Licence: NM PT22034) | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2023-01-27 |