| NPI | 1376994558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10815) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 10815) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-09-07 |