| NPI | 1992961072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1124949) |
| 225100000X Physical Therapist (Licence: SD 1170) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2022-01-07 |