| NPI | 1083703490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1140028) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1140028) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-05-22 |