| NPI | 1609383637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1300956) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: TX 1300956) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2021-06-05 |