| NPI | 1477953495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1247769) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 3115648) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2022-07-21 |