| NPI | 1568851723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1253931) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1253931) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2023-10-12 |