| NPI | 1508279084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11499) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT.014820) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2023-06-29 |