| NPI | 1659807279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 8321467-2401) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2026-02-06 |