| NPI | 1598834178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1135044) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 9316) |
| 225500000X Specialist/Technologist (Licence: TX 1135044) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2008-09-15 |