| NPI | 1134419500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1143782) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1143782) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2011-04-19 |