| NPI | 1780605261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000010226) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA PT21420) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2015-02-03 |