| NPI | 1710346036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1375100) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT025043) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2024-03-28 |