| NPI | 1598985319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1114403) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NM 3308) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |