| NPI | 1831158112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 6126) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: TN 6126) |
| 2251S0007X Physical Therapist, Sports (Licence: TN 6126) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TN 6126) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-07-21 |