| NPI | 1174739866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1171468) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2015-04-20 |