| NPI | 1588150270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1309347) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1309347) |
| 225100000X Physical Therapist (Licence: SC 9640) | |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2022-12-30 |