| NPI | 1235113754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1076438) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1076438) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2025-04-23 |