| NPI | 1477043537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1319922) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2023-09-05 |