| NPI | 1487107728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1312118) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 291704) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2018-11-02 |