| NPI | 1427271246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 7943) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305005311) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-07-19 |