| NPI | 1861646259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 17052) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030693-1) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2026-07-23 |