| NPI | 1184811804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 7915) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2017-04-21 |