| NPI | 1700124286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 7038) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 35123) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-01-17 |