| NPI | 1477806305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1219036) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: TX 1219036) |
| 2251S0007X Physical Therapist Sports (Licence: TX 1219036) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: TX 1219036) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2012-10-16 |