| NPI | 1346764305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 11494) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11494) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2022-03-23 |