| NPI | 1194371815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1341117) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT027752) |
| Enumeration Date | 2019-08-18 |
| Last Update Date | 2021-08-03 |