| NPI | 1710618889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1352811) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1352811) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2023-06-29 |