| NPI | 1821033473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT1712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT3534) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TN PT1712) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2021-03-28 |