| NPI | 1174036065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD CP053876T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11558) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2026-02-26 |