| NPI | 1316227515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT4918) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10294) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MS PT4918) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2023-01-31 |