| NPI | 1003849803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000003108) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004814) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2024-05-04 |