| NPI | 1225405749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 174H00000X Health Educator (Licence: TX 1262879) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2022-01-20 |