| NPI | 1053470567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1111524) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TX 1111524) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2016-06-29 |