| NPI | 1477601961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12546359-2401) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1165590) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2023-04-26 |