| NPI | 1861153694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14684) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P20220) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2022-12-08 |