| NPI | 1346533254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1322971) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 11177) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2025-01-21 |