| NPI | 1053792556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P16388) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1259603) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2017-07-19 |