| NPI | 1093161259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MS PT5926) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 11307) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2022-07-21 |