| NPI | 1962856203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 16431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012027A) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2018-11-23 |