| NPI | 1912301607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1248545) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2022-01-19 |