| NPI | 1003252891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 1896) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TN PT0000001896) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2021-02-26 |