| NPI | 1982762829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1177573) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028798) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2024-08-22 |