| NPI | 1235541616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1241070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208551) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2019-01-14 |