| NPI | 1467787341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 9477) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12359) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2023-10-13 |