| NPI | 1154737740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: TX 1168625) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TX 1168625) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1168625) | |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2015-11-11 |