| NPI | 1053687541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000010202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT4734) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2015-01-06 |