| NPI | 1477640050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TN 2111) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: GA 004764) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2008-06-02 |