| NPI | 1548496656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1168180) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AK 137405) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2023-11-06 |