| NPI | 1891189593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1256788) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 20311) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |