| NPI | 1639420425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1257373) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 39123) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2016-07-24 |