| NPI | 1508912791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1175929) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 29577) |
| 225100000X Physical Therapist (Licence: TX 1175929) | |
| 2251N0400X Physical Therapist, Neurology (Licence: CA 29577) | |
| 2251N0400X Physical Therapist, Neurology (Licence: TX 1175929) | |
| 2251S0007X Physical Therapist, Sports (Licence: CA 29577) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 29577) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1175929) | |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2007-12-11 |