| NPI | 1790265528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1151923) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TX 1151923) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: TX 1151923) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-08-21 |