| NPI | 1992106736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TN 8803) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MS 4589) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2014-09-11 |