| NPI | 1811338445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: UT 5477970-2402) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 5477970-2402) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2013-07-11 |