| NPI | 1992028856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1018646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 2406) |
| 2251S0007X Physical Therapist, Sports (Licence: TX 1018646) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1018646) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CO 2406) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2010-03-08 |