| NPI | 1790442390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1355268) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA CP008918T) |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2022-11-10 |