| NPI | 1710407457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1384183) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2017026978) |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2024-02-20 |