| NPI | 1316914575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 1648) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT9108) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MT 1648) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2017-05-11 |