| NPI | 1508424821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1315715) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: TX 1315715) |
| Enumeration Date | 2019-06-01 |
| Last Update Date | 2019-06-01 |