| NPI | 1457628729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 14325) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT 35083) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2023-05-22 |