| NPI | 1043645658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 6404) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9747) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2018-01-02 |