| NPI | 1629395439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1178237) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports |
| 2251N0400X Physical Therapist Neurology | |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2023-08-20 |