| NPI | 1124404751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1262665) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 3114541) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2021-04-30 |