| NPI | 1780056713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TN 8143) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MS 5033) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2015-10-29 |