| NPI | 1417022971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT0811) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TN 1837) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2019-03-05 |