| NPI | 1669007761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1327551) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: TX 1327551) |
| 2251S0007X Physical Therapist Sports (Licence: TX 1327551) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2023-08-15 |