| NPI | 1639696669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1293395) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1293395) |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2022-07-21 |