| NPI | 1457339889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1300771) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IN 05005082A) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2018-07-11 |