| NPI | 1457456246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: TX 143545) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 143545) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |