| NPI | 1720555212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1271229) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX 1271229) |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2020-01-06 |