| NPI | 1306493812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT015162) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013487A) |
| 2251S0007X Physical Therapist, Sports (Licence: GA PT015162) | |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2021-03-04 |