| NPI | 1477872216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TN 3656) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 3656) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH7317) | |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2025-05-23 |