| NPI | 1780850057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1190121) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 7037) |
| 225100000X Physical Therapist (Licence: TX 1190121) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2010-01-19 |