| NPI | 1619218104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 1424) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TN 0000001424) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TN 0000001424) | |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2024-05-02 |