| NPI | 1497037188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1190952) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: TX 1190952) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1190952) | |
| Enumeration Date | 2011-09-19 |
| Last Update Date | 2022-12-16 |