| NPI | 1649740200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1331811) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: FL PTT34225) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2023-10-05 |