| NPI | 1326295734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1223600) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT019377) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2014-05-16 |