| NPI | 1134505183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1265410) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2020-08-03 |