| NPI | 1528328705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 339308-2401) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2024-05-16 |