| NPI | 1073826889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8710) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT28671) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2019-04-16 |