| NPI | 1962567602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 114459-2401) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 114459-2401) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2019-12-27 |